Sharing a New Ideal: How Tomorrow’s Understaffed, Multi-Site Lab Organization Will Combine Automation, Technology, and Performance Improvement To Meet Its Mission
- 1. Chris Christopher Vice President, Global Customer Solutions Siemens Healthcare Diagnostics Sharing a New Ideal: How Tomorrow's Understaffed, Multi-Site Lab Organization Will Combine Automation, Technology, and Performance Improvement To Meet Its Mission
- 2. Page 2 Purpose & Objectives PURPOSE Provide an overview of the dynamics of today’s IVD industry with emphasis on how tomorrow’s key organizations will be using automation, technology, quality management and performance indicators to raise the bar in meeting customer satisfaction. OBJECTIVE Gain insights into the dynamics of today's multi-site clinical laboratory organization, the challenges it faces, and approaches used to enhance performance in support of its mission.
- 3. Page 3 For Starters… Similarities of High Performing Labs to Auto Racing Formula One Grand Prix Race Drag Race Daytona Race
- 4. Page 4 Market Segmentation: Similarity Hospital Labs Grand Prix Average Speed MEDIUM ~ 30 to 50% of Top End Peak Duration Short to Medium Intervals Backup Capacity Good Productivity Medium KPI STAT Turn Around Time
- 5. Page 5 Market Segmentation: Similarity Reference Labs Daytona Average Speed HIGH ~ 85% of Top End Peak Duration Long Backup Capacity Low < 25% Productivity Very High KPI Finish Line 0 200 400 600 800 1,000 1,200 1,400 1,600 0:00 2:00 4:00 6:00 8:00 10:00 12:00 14:00 16:00 18:00 20:00 22:00 Time of Day Number of Total Samples Checked Into ADVIA LabCell By Hour (May 6/7)
- 6. Page 6 Market Segmentation: Similarity Emergency Labs Drag Strips Average Speed Short Burst Peak Duration Short Backup Capacity Central Lab Productivity Low Price Sensitivity Low KPI Turn Around “Time is Tissue” 0 2 4 6 8 10 12 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Hour Rcvd. #Accessions
- 7. Today’s IVD Industry Trends and Challenges in Multi-Site Lab Combining Automation, Technology, and Performance Improvement Presentation Agenda Workflows Discussion / Needs Mission
- 8. The Lab is a Vital Contributor to the Healthcare Network Hospital Hospital Clinic Healthcare System Affiliated Physician Practices Patient’s Home Independent Physician Practices Health System Physician Practices Laboratory L-T Care Surgi-Center Imaging Center Outpatient Rehab
- 9. Today’s IVD Market Approximately 70 percent of the medical decisions are based upon the data obtained from laboratory testing performed by medical technologist/clinical laboratory scientists. 1 Tests today are performed today in many locations: Clinical laboratory Physician Office Satellite locations Patient Home / Residence Increasing Pressure to Decrease Costs Improve Productivity / Quality / TAT Reduce Errors Source: The University of Southern Mississippi Medical Technology
- 10. IVD Market Developments Demand Drivers Source: American Association for Clinical Chemistry LabTest Online® October 2010 1. Improve early detection and diagnosis of diseases 2. Increase accuracy 3. Better predict outcomes (prognosis). 4. Improve productivity by automating methods
- 11. IVD Market Developments Rapid advancements in new tests driven by research, personalized medicine, and tailored treatment New technology / methods Growing emphasis in Molecular and Genetic testing Expanding Point of Care Self testing for chronic sufferers Fueling Growth Source: Boston Biomedical Consultants, Inc. October 2010
- 12. Today’s IVD Industry Trends and Challenges in Multi-Site Lab Combining Automation, Technology, and Performance Improvement Presentation Agenda Workflows Discussion / Needs Mission
- 13. Trends & Challenges in Demand for Testing $49,843.5m by 2016 at the CAGR of 4.3% over the next seven years DRIVERS: 1) New technological advancements 2) A shift towards more complex immunochemistry tests to Point of Care (POC) 3) The adoption of cost cutting measures such as increased automation and self testing. Source: GBI Research January 2010CAGR (Compounded Annual Growth Rate) IVD Anticipated Growth over Next 6 Years
- 14. Complexities in Laboratory Management N. America Skilled Labor Shortages Attracting and retaining skilled labor Aging workforce Tight money supply Lack of Capital to Invest Little or no money to remodel Effective data management Need for integrated diagnosis Real-time management dashboard tracking metrics Partnering with Medical Staff to enhance patient care C H A L L E N G E S
- 15. Challenges in today’s laboratories worldwide Error Reduction impacting Quality and Performance Labeling at the Source of Collection C H A L L E N G E S
- 16. Today’s IVD Industry Trends and Challenges in Multi-Site Lab Combining Automation, Technology, and Performance Improvement Presentation Agenda Workflows Discussion / Needs Mission
- 17. Three Independent WORKFLOWS within the Clinical Laboratory are Defined by Instrument Order Instrument Data Flows Sample Flows Material Flows Results Collect Process Store / Retrieve / Discard Order Inventory Consume
- 18. Details on the FLOWS Specimen Collection Sample Sorting Physical Sample Transport Centrifugation Decapping Sample Flow Recapping Sample Archiving Sample Location & Retrieval Sample Disposal Sendouts Order Entry Electronic Medical Records Accessioning Quality Control Outreach Data Flow Autovalidation Result Review & Validation Decision Support Result Reporting Billing Instrument Inventory Mgmt Laboratory Inventory Mgmt Equipment Monitoring Equipment Maintenance Remote Service Material Flow eCommerce Utilization Reporting Cost Per Result Management Automated Invoicing Electronic Payment Instruments / Automation Chemistry Immunoassay Hemostasis Hematology Microbiology All other The Lab is a highly complex 24/7 business with many inputs and outputs!!!
- 19. Workflow Optimization Using Quality Management Tools “Rapid Improvement Event” Focus: Eliminate Waste Key Tool: Value Stream Map Look for: Consolidation of Processes Promote: Continuous Flow vs. Batch Resources: Cross functional team Optimize processes in the ED and LAB using Lean / Six Sigma Quality Management Solutions Sample Flows Lab Patient Flows ED Information Flows
- 20. Today’s IVD Industry Trends and Challenges in Multi-Site Lab Combining Automation, Technology, and Performance Improvement Today’s Agenda Workflows Discussion / Needs Mission
- 21. Today’s Best Practice Laboratory is Driving … … Process Improvement across the Healthcare Network
- 22. Example #1 – Focus on Performance Improvements Healthcare Innovation: “Getting It Right: Perfecting the Patient Experience,” has been a key factor in reducing waste in our system and improving the bottom line, while at the same time it has enhanced efficiency and ensured continued high quality of care.” Source: Denver Health 2008/09 Annual Reports Uncompensated care increased from $318 million in 2008 to $362 million in 2009 “Denver Health’s Response to Rising Cost”
- 23. Example #1 “Denver Health’s Response to Rising Cost” Example Healthcare Innovation: Source: Denver Health 2008/09 Annual Reports “A good deal of credit for our success in remaining financially viable this year goes to our LEAN initiative, which, through process improvement efforts, has reduced waste in every corner of our health care delivery system. Using the principles of LEAN, employees throughout the enterprise joined together in three to five cross-departmental groups twice each month, and focused attention on specific areas in which waste can be removed. In 2009, the initiative gained significant momentum, and $24 million of the $42 million total financial benefit occurred in this year alone. One significant source of pride emanating from our transformation project is our unique development of an internal corps of LEAN Black Belt experts – the only one of its kind in the nation. We have trained 200 employees, from surgeons to mid-level managers, in the principles of LEAN. They then look to reduce waste every day in their departments. Black Belt projects accounted for $8.8 million of the total $42 million in financial benefit.
- 24. Lean Quality Management Driven Visual Cues; Measurements; Priority Management Effective Use of Non Technical Labor Electronic Archival Tracking for Central Lab Auto Verification and Auto Release Smiling Faces Best Practices Overall Operation Note worthy: Denver Health operates a Highly Complex Clinical Diagnostics Lab with ~100s customized order capability and multiple priorities... SpecTRACK
- 25. Best Practices KPI: In Lab Turn Around Time • In Lab Commitment: 30 minute TAT at 90th percentile (Most Labs in N. America: 45 to 60 mins. For Troponin) Troponin Turnaround Times, Average 0 10 20 30 40 50 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month Minutes 2008 2009 2010 • In Lab Monitoring for Chemistry: STAT Alert > 20 minute TAT
- 26. Page 26 26 Focus on Continuous Performance Improvement Example: Lean Project Plan and Summary # Name/Description Lead Start Date End Date JDI RIE Project 5 Outpatient Charge Capture – Facility Billing Billing 9/13/10 X 2 Outpatient Lab Ordering Order Entry 10/11/10 X 5a Physician Billing Charge Capture Billing 11/8/10 X 1 CHS Outpatient Flow Operations 12/13/10 X 1a Pre-analytical Standard Work Lab 1/10/10 X 9 Specimen Collection Standard Work Lab 8/1/10 8/1/11 X 12 Resulting Standard Work Lab 2/7/11 X 18 Specimen Management Lab 8/1/10 12/31/10 X 16 Anatomic Pathology Standard Work AP 3/7/11 X 13 IT/Lab Optimization IT / Lab 4/4/11 X 14 Hazardous Materials – RCRA Operations 8/2/10 8/2/10 X
- 27. Example #2 – Solving Tough Problems in Operations Source: April Gamache Sr. Vice President Operations October 2010 “Driving Operational Excellence Daily” Provides > 50 millions lab tests to over 10 million patients and nearly 20,000 physicians in Canada Toronto Lab Processes more than 18K Samples per day in Chemistry with installation of a Single Line Automation in 2008 Continuous Operations 24/7 Faces Labor Shortages Highly Regulated Quality Focused
- 28. Example #2 – Solving Tough Problems in Operations Underlying Strategies to “Driving Operational Excellence” Establish an Environment of Continuous Improvement Establish a Common Language & Tool Kit Implement Rigorous Measurement Processes – Start with the Facts Learn from Mistakes Adopt Best Practice (UPS for tracking samples) Improve Capabilities to Solve Problems as they are identified Create an Organization of Mentors Expand Knowledge within the organization Source: April Gamache Sr. Vice President Operations October 2010
- 29. Combining Automation, Technology, and Performance Improvement Value Stream Map – Optimize Processes -- Automate – Measure – Workload Balance – Seek Further Improvement Balance Load Tools Process Environment/Materials People Knowle dge L ev el Clea r Roles for Tray Managem ent Av ailability of L abour L oading Protocol Visual ID of Deliv ery & Balance Issues Gate Scanners Throughput Capability Queue Design Routing L ogic Hours of Operation Tray Configuration L ine Configuration/L ay out Test Density Test Mix Tube Mix (load sensitiv e) SM L oading Protocol Tray Configuration Work Instruction Downtim e Dashboard Throughput Ca lculator Sim iulation Tool Throughput Data No Read Queries respo nse to cu e S ta nd ar d wo rk Un de rsta nd C ue s Tr a ys /O n/OffT im ely Preso rt in g S ta nd ar d W or k De ploy m en t N um b er Brea ks Th ro ug h ou tD ay Va riab ility Re ad sN o S et tin gsMgm tPu ck Pu ck s&No . Le n gthLi ne r Ma na geSa m pl e An al yz er SIQ Pr oc es sPa rtial S ta rt 7 -1 0a m r An a ly zeBy P rioritie s r Man ag eSa m pl e An al yz e r Eq ui pm e nt A ssa ys R ep e at s Re use of Ho le s T im ely P re so rti ng St a nda rd W or k tro ub le sh oo tin g da ta L ac k of S IQ tray La ck ofC /T ale rt Cause and Effect (Y = Load Balance)
- 30. Lab Operations Dashboard 30 Visual management of the automation line • Expected levels of tube processing allows technologists & technicians the ability to identify problems before they impact expected specimen turn- around times • The red/yellow/green indicators also indicate severity of the issues and prompt the right response for lab personnel to take with the system
- 31. Specimen Management Dashboard 31 • “Web portals were established to provide real- time receipt of specimens by the various types required to be resulted” • “This enabled operations group to identify potential backlogs that could occur and take appropriate action to resolve” Michael Hartman Lean Sigma Master Black Belt
- 32. Focus on Process Improvement 32 Instrument Downtime Centaur Chemistry Track Sample Mangers Probes/Tubing Heaters/Thermistors Probes Barcode Readers H/W Cx Errors Belt/Drive H/W Robot Arm QC Issues Mixers Switches DPP ISE Issues Gates/Diverters H/W CentraLink Scheduled Maintenance Scheduled Service Maint. PM’s Software Mgmnt SPP RPP1,2 DTT Hardware Pumps Fluidics Optics Software User Electronics Cooling Computer Software Settings Patches Communication Ancillary Queue Ribbon Cables Tip Drawer H/W RP1/2 RT Computer H/W General H/W Belts Luminometer Ring Vacuum Plugged Lines 26 26 4 9 4 • “With the automation taking care of processing, operations could focus on identifying issues with capacity” • “Lean Sigma played a critical role in unlocking the true capacity of the platform and providing a framework for ongoing improvement” Root Cause Analysis Michael Hartman Lean Sigma Master Black Belt
- 33. These are two great examples of where Multi-Site Lab Organization are Combining Automation, Technology, and Performance Improvement To Meet Its Mission Chartering the Future
- 34. Looking ahead … where’s the next major opportunity
- 35. As an Industry, we must solve Today’s Complex Connectivity and….
- 36. Meet the Laboratory’s Needs with a Common Language for Communications that contributes to Efficient Process Control i2i A Common Language for Communication between Instruments and IT
- 37. The Lab’s Formula for Success Thank You Driving Hard while Combining Automation, Technology, and Performance Improvement